麻醉苏醒期电复律对老年患者肺切除手术中新发心房颤动的近期效果

Short-term therapeutic effects of cardioversion during anesthesia recovery period on new-onset atrial fibrillation in elderly patients undergoing lung resection operations

目的探讨麻醉苏醒期电复律对老年患者肺切除手术中新发心房颤动(房颤)的近期效果。方法选择上海市胸科医院麻醉科2017年1月1日—2019年12月31日60岁及以上行肺部手术术中新出现房颤的老年患者90例(房颤组),于麻醉苏醒期行双相电复律。另设术中无新发房颤的90例为对照组(根据年龄、性别、身高、体质量、手术时间、手术方式、手术侧、ASA分级采用倾向性评分匹配)。两组术后均采用多模式镇痛。观察房颤组电复律治疗后复律效果,比较两组术后房颤的发生率。结果房颤组麻醉苏醒期电复律成功率达97.7%(88/90)。术后7天内,房颤组发生房颤14例(15.5%,14/90);对照组发生房颤12例(13.3%,12/90);两组房颤发生高峰时间出现在术后2~3天。Kaplan-Meier分析显示,术后无房颤发生率两组比较差异无统计学意义(P=0.431)。所有房颤患者出院前均恢复窦性心律。结论术中新发房颤的老年肺部手术患者在麻醉苏醒期采用电复律可快速有效消除房颤,恢复窦性心律。电复律治疗后,其术后房颤发生率与术中无新发房颤患者无差异。

Objective To explore short-term therapeutic effects of cardioversion during anesthesia recovery period on new-onset atrial fibrillation(NOAF)in elderly patients undergoing lung resection operations.Methods A total of 90cases of intraoperative atrial fibrillation(AF)in elderly patients aged 60 and above who undergoing lung resection operations from January 1,2017 to December 31,2019(AF group)were selected from the Anesthesiology Department of Shanghai Chest Hospital.Those patients in AF group received biphasic cardioversion during recovery period after surgery.Among patients who did not develop NOAF during lung surgery,90 patients were selected and assigned to the control group through propensity score matching according to patient’s age,gender,height,weight,operation time,operation approach,operation laterality,ASA classification.Both of the primary outcome including the effects of cardioversion on NOAF and the second outcomes including postoperative occurrence or recurrence ratio in two groups were analyzed.Results Incidence of successful cardioversion during recovery period in those elderly patients with intraoperative NOAF was 97.7%(88/90).Within postoperative 7 days,postoperative AF(POAF)occurred in 14 patients with the incidence of 15.5%(14/90)in AF group,and 12 patients(13.3%,12/90)in the control group.The peak time of POAF occurrence was on the postoperative second or third day.The Kaplan-Meier analysis showed no statistic difference in postoperatively accumulate non-AF ratios between two groups(P=0.431).Sinus rhythm were achieved before discharge in all patients with POAF.Conclusions Cardioversion is a quick and effective therapeutic method during recovery period for intraoperative NOAF in elderly patients undergoing lung resection operations.The incidence of POAF reoccurrence after successful cardioversion is similar to that in patients without intraoperative NOAF.